How to hire a medical claims specialist

How to hire a medical claims specialist, step by step

Here's a step-by-step medical claims specialist hiring guide:

• Step 1: Identify your hiring needs
• Step 2: Create an ideal candidate profile
• Step 3: Make a budget
• Step 4: Write a medical claims specialist job description
• Step 5: Post your job
• Step 6: Interview candidates
• Step 7: Send a job offer and onboard your new medical claims specialist
• Step 8: Go through the hiring process checklist

What does a medical claims specialist do?

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1. Identify your hiring needs

   First, determine the employments status of the medical claims specialist you need to hire. Certain medical claims specialist roles might require a full-time employee, whereas others can be done by part-time workers or contractors.

   Determine employee vs contractor status

   Is the person you're thinking of hiring a US citizen or green card holder?

   Yes

   No

   You should also consider the ideal background you'd like them a medical claims specialist to have before you start to hire. For example, what industry or field would you like them to have experience in, what level of seniority or education does the job require, and how much it'll cost to hire a medical claims specialist that fits the bill.

   The following list breaks down different types of medical claims specialists and their corresponding salaries.

   Type of Medical Claims Specialist	Description	Hourly rate
   Medical Claims Specialist	Medical records and health information technicians, commonly referred to as health information technicians, organize and manage health information data. They ensure its quality, accuracy, accessibility, and security in both paper and electronic systems... Show more	$13-20
   Billing Representative	A billing representative assists with the overall operations of the organization's billing department. Billing representatives post payments timely on the database, update account statements, generate financial reports, release invoices, and resolve account discrepancies... Show more	$13-20
   Health Information Technician	A health information technician is primarily responsible for managing and handling patient information, ensuring accuracy and confidentiality. They coordinate with various health care workers to gather patient data, laboratory results, test findings, and medical histories, encoding them in clinical databases in a timely and efficient manner... Show more	$12-21

   Show more

2. Create an ideal candidate profile

   Common skills:

   • Customer Service
   • Patients
   • Medicaid
   • Medical Billing
   • Phone Calls
   • Medical Terminology
   • EOB
   • Medical Treatment
   • Data Entry
   • Telephone Calls
   • Medical Documentation
   • Appeals
   • Medical Necessity
   • Paper Claims

   Check all skills

   Responsibilities:

   • Apply Medicare, Medicaid billing guidelines to achieve maximum reimbursement.
   • Detail knowledge of medical coding; ICD-9, CPT and HCPCS codes.
   • Confirm coverage and work with private payers, commercial payers, Medicaid, and Medicare for reimbursement of provide medical services.
   • Research medical records, compliance requirements and explanations of benefits to resolve accounts payable for Medicare, Medicaid and commercial insurance.
   • Maintain strict confidentiality/privacy of patients' protect health information in accordance with HIPAA regulations.
   • Assist in educating new hires in HIPPA laws and training.

   More medical claims specialist duties

3. Make a budget

   Including a salary range in your medical claims specialist job description helps attract top candidates to the position. A medical claims specialist salary can be affected by several factors, such as geography, experience, seniority, certifications, and the prestige of the hiring company.

   For example, the average salary for a medical claims specialist in New Mexico may be lower than in Connecticut, and an entry-level medical claims specialist usually earns less than a senior-level medical claims specialist. Additionally, a medical claims specialist with certifications may command a higher salary, and working for a well-known company or start-up may also impact an employee's pay.

   Average medical claims specialist salary

   $35,706yearly

   $17.17 hourly rate

   ---

   Entry-level medical claims specialist salary

   $28,000 yearly salary

   Updated January 23, 2026

   Average medical claims specialist salary by state

   Rank	State	Avg. salary	Hourly rate
   1	Massachusetts	$43,192	$21
   2	Connecticut	$43,157	$21
   3	Vermont	$42,518	$20
   4	Minnesota	$39,635	$19
   5	Georgia	$39,191	$19
   6	New Jersey	$38,441	$18
   7	Tennessee	$38,297	$18
   8	Indiana	$38,275	$18
   9	New York	$38,064	$18
   10	California	$38,056	$18
   11	Pennsylvania	$37,675	$18
   12	Nevada	$37,522	$18
   13	Colorado	$36,894	$18
   14	North Carolina	$35,332	$17
   15	Wisconsin	$34,809	$17
   16	Michigan	$34,595	$17
   17	Iowa	$34,458	$17
   18	Illinois	$34,434	$17
   19	Texas	$33,998	$16
   20	Arizona	$33,513	$16

   Average medical claims specialist salary by company

   Company

   Rank	Company	Average salary	Hourly rate	Job openings
   1	Total Medical Personnel Staffing	$37,901	$18.22
   2	CorVel	$36,663	$17.63	137
   3	University of Rochester	$36,616	$17.60	3
   4	Professional Staffing Group	$36,339	$17.47
   5	Nationwide	$36,297	$17.45	51
   6	The Jonus Group	$36,289	$17.45	82
   7	Lee Hecht Harrison	$36,058	$17.34
   8	Emergis	$36,001	$17.31
   9	ABC Supply Co	$35,461	$17.05
   10	J. Morrissey & Company	$35,090	$16.87	1
   11	Robert Half	$34,980	$16.82	102
   12	Ajilon Consulting	$34,806	$16.73
   13	Community Surgical Supply	$34,458	$16.57
   14	Randstad North America, Inc.	$34,449	$16.56	9
   15	Kelly Services	$34,350	$16.51	14
   16	Elite Care	$34,108	$16.40	1
   17	Broward Health	$34,073	$16.38	3
   18	Berkshire Hathaway	$33,905	$16.30	46
   19	Aerotek	$33,630	$16.17	17
   20	CornerStone Staffing	$33,389	$16.05	1

4. Writing a medical claims specialist job description

   A job description for a medical claims specialist role includes a summary of the job's main responsibilities, required skills, and preferred background experience. Including a salary range can also go a long way in attracting more candidates to apply, and showing the first name of the hiring manager can also make applicants more comfortable. As an example, here's a medical claims specialist job description:

   Medical claims specialist job description example

   Medical Claims Specialist – 100% REMOTE / Work From Home!!!

   Our client is a national leader in business process as a service (BPaaS) in business process outsourcing (BPO) of medical claims in the Medicare Advantage and Managed Medicaid
   markets.

   Our client is looking for a number of full-time Medical Claims Specialists who will work 100% remote from their homes, which means they can live anywhere in the U.S. Our client DOES NOT provide sponsorship for U.S. employment, and candidates must be authorized to work in the U.S.

   Our client’s corporate offices are located in the northern suburbs of Philadelphia.

   This Medical Claims Specialist will be required to perform reviews of pended claims of all types and specialties, apply business rules, and finalize claims in accordance with regulatory and client expectations.

   RESPONSIBILITIES of a Medical Claims Specialist:

   • Perform timely and accurate claim adjudication and adjustments.
   • Prepare encounters for submission and correct rejected encounters.
   • Identify opportunities to improve efficiency within assigned processes.
   • Research and review Claims Appeals information to support client inquiries.
   • Support system inquiries documented from the member and provider call center services.
   • Adjudicate specialty claims, including ambulatory surgery, skilled nursing, dental, anesthesia, medical assistance, reprocessed claims, duplicate claims, ambulance, durable medical equipment (DME), or institutional-based charges.

   REQUIREMENTS of a Medical Claims Specialist:

   • 1 to 3 years of Medicare Advantage and Managed Medicaid experience.
   • Experience in working in a remote BPaaS environment with performance standards.
   • Excellent attention to detail and phone communication skills.
   • Excellent written communication skills.
   • Proficient with Microsoft Office Outlook, Word and Excel, and Adobe Standard.

   This Medical Claims Specialist position provides an hourly range of $14.00 to $17.50 per hour commensurate with experience along with benefits that include: Medical (pays 75% of selected coverage), Dental, 401(k) with match, Life, STD, LTD, 5 weeks PTO, and 10 paid Holidays.

   **PLEASE APPLY TO BE CONSIDERED**

   Copy this example

   

5. Post your job

   To find medical claims specialists for your business, try out a few different recruiting strategies:

   • Consider internal talent. One of the most important talent pools for any company is its current employees.
   • Ask for referrals. Reach out to friends, family members, and your current work to ask if they know any medical claims specialists they would recommend.
   • Recruit at local colleges. Attend job fairs at local colleges to recruit entry-level medical claims specialists with the right educational background.
   • Social media platforms. LinkedIn, Facebook, and Twitter have more than 3.5 billion users, and they're a great place for company branding and reaching potential job candidates.

   To find medical claims specialist candidates, you can consider the following options:

   • Post your job opening on Zippia or other job search websites.
   • Use niche websites that focus on engineering and technology jobs, such as healthcarejobsite, health jobs nationwide, hospitalcareers, medreps.com.
   • Post your job on free job posting websites.

6. Interview candidates

   Your first interview with medical claims specialist candidates should focus on their interest in the role and background experience. As the hiring process goes on, you can learn more about how they'd fit into the company culture in later rounds of interviews.

   You should also ask about candidates' unique skills and talents to see if they match the ideal candidate profile you developed earlier. Candidates good enough for the next step can complete the technical interview.

   The right interview questions can help you assess a candidate's hard skills, behavioral intelligence, and soft skills.

7. Send a job offer and onboard your new medical claims specialist

   Once you've selected the best medical claims specialist candidate for the job, it's time to write an offer letter. In addition to salary, this letter should include details about the benefits and perks you offer the candidate. Ensuring that your offer is competitive is essential, as qualified candidates may be considering other job opportunities. The candidate may wish to negotiate the terms of the offer, and you should be open to discussion. After you reach an agreement, the final step is formalizing the agreement with a contract.

   It's also important to follow up with applicants who do not get the job with an email letting them know that the position is filled.

   After that, you can create an onboarding schedule for a new medical claims specialist. Human Resources and the hiring manager should complete Employee Action Forms. Human Resources should also ensure that onboarding paperwork is completed, including I-9s, benefits enrollment, federal and state tax forms, etc., and that new employee files are created.

8. Go through the hiring process checklist

   • Determine employee type (full-time, part-time, contractor, etc.)
   • Submit a job requisition form to the HR department
   • Define job responsibilities and requirements
   • Establish budget and timeline
   • Determine hiring decision makers for the role
   • Write job description
   • Post job on job boards, company website, etc.
   • Promote the job internally
   • Process applications through applicant tracking system
   • Review resumes and cover letters
   • Shortlist candidates for screening
   • Hold phone/virtual interview screening with first round of candidates
   • Conduct in-person interviews with top candidates from first round
   • Score candidates based on weighted criteria (e.g., experience, education, background, cultural fit, skill set, etc.)
   • Conduct background checks on top candidates
   • Check references of top candidates
   • Consult with HR and hiring decision makers on job offer specifics
   • Extend offer to top candidate(s)
   • Receive formal job offer acceptance and signed employment contract
   • Inform other candidates that the position has been filled
   • Set and communicate onboarding schedule to new hire(s)
   • Complete new hire paperwork (i9, benefits enrollment, tax forms, etc.)

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How much does it cost to hire a medical claims specialist?